Objective To investigate whether calcineurin is upregulated along with podocytes injury in anti-glomer-ular basement membrane ( GBM) disease, and the relationship with the clinicopathological characters and the kidney survival. Methods The expression of a isoform of calcineurin A subunit (CnAα) and synaptopodin was detected by immunohistochemistry and immunofluorescence, respectively, in renal biopsy tissues from 29 patients with anti-GBM disease compared with 8 cases with glomerular minimal lesion as control. And we analyzed the relationship between CnAa expression and the clinicopathological manifestations and outcome of anti GBM disease. Results CnAα was upregulated in all anti-GBM disease patients, with the positive area significantly larger than that of glomerular minimal lesion (21. 63% ± 14. 27% vs 2. 21% ± 1. 41% ,P <0. 01). The expression of CnAα, with loss of synaptopodin, correlated well with anti-GBM antibody titer, SCr, HGB, crescents, cellular/fibrocellular crescent proportion and the renal outcome. Conclusions It was found that the overexpression of CnAα showed good correlation with anti-GBM disease activity, severity and prognosis, which suggested that podocyte injury takes part in crescents formation. The mechanism involved requires further research.%目的 观察抗肾小球基底膜(GBM)病患者肾小球足细胞钙调神经蛋白(CaN)的表达,了解其与临床病理特点及肾脏长期存活的关系.方法 选取临床病理资料完整的抗GBM病患者29例,对照为8例肾小球轻微病变患者.收集患者临床资料,免疫组化方法检测CaN A亚基α亚单位(CnAα)在肾小球的表达,免疫荧光染色观察足细胞骨架蛋白synaptopodin表达,分析CnAα与临床病理表现及预后的关系.结果 29例抗GBM病患者肾小球内均有不同程度的CnAα表达阳性,阳性区域占肾小球面积百分比显著高于轻微病变者(21.63％±14.27％ vs2.21％ ±1.41％,P＜0.01),同时伴有synaptopodin缺失.CnAα的表达量与抗GBM抗体峰值、血肌酐水平、血红蛋白水平、新月体比例及细胞/细胞纤维新月体比例呈现显著相关性,并与预后相关.结论 首次观察到抗GBM病患者肾小球内CnAα表达增强,表达量与疾病活动、严重程度及预后相关,提示足细胞可能参与抗GBM病新月体形成,其作用机制仍有待进一步研究.
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